Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"A Novel Retrievable Drug Infusion Stent and Blood-Brain Barrier Portal for Antibody Therapies to the Spinal Cord.","authors":"Jordan F Stafford, Dahlia M Kenawy, Jan M Schwab, Foued Amari, Drayson Campbell, Bryan W Tillman","doi":"10.1227/ons.0000000000001640","DOIUrl":"https://doi.org/10.1227/ons.0000000000001640","url":null,"abstract":"<p><strong>Background and objectives: </strong>The blood-brain barrier (BBB) is prohibitive to intravascular drug delivery. We hypothesized that isolation of spinal cord perfusion would focus on a higher effective dose while minimizing systemic toxicity and that a histamine portal would increase BBB permeability and facilitate large molecule therapies to the spinal cord.</p><p><strong>Methods: </strong>A dumbbell-shaped, retrievable drug infusion stentgraft (RDIS) was constructed from nitinol and polytetrafluorethylene. A porcine model under anesthesia underwent percutaneous femoral insertion of the sheathed RDIS and deployment in the lower thoracic aorta by sheath withdrawal. Antiglial fibrillary acidic protein (GFAP) tracer antibody was instilled to the outer chamber for 30 minutes +/- 80 μg of histamine, followed by stent recovery by sheath advancement, staining of spinal cord with fluorescent secondary antibody, and measurement of mean fluorescence intensity.</p><p><strong>Results: </strong>Angiography confirmed center lumen distal perfusion while an integrated cannula allowed infusion to the isolated outer chamber and intercostals. Although 80 μg of histamine delivered intravenously decreased the mean arterial pressure by 22 mm Hg briefly but significantly (P = .002), histamine infused into the RDIS outer chamber did not exhibit hypotensive effect. Animals treated using RDIS + histamine + GFAP (n = 5) revealed increased mean fluorescence intensity (mean 1074 ± 199) compared with either RDIS + GFAP without histamine (n = 5; 792 ± 223, P < .002) or simple IV infusion of GFAP + histamine (n = 5; 748 ± 172, P < .001). Although the stent perfused only 2-3 sets of intercostals, positive staining was observed well into the adjacent upper thoracic and lumbar spinal cord.</p><p><strong>Conclusion: </strong>An RDIS achieves focal drug delivery of antibody to the spinal cord and is retrievable after use, whereas a histamine portal facilitates passage across the BBB. The RDIS may have future utility for vascular-based delivery of antibody therapeutics or other macromolecules focused to the spinal cord for oncological, spinal cord injury and neurodegenerative disease.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing a Three-Column Osteotomy with a Construct-To-Construct Closure: Case Series and Technical Note With Intraoperative Pictures and Videos.","authors":"Harsh Jain, Ranbir Ahluwalia, Iyan Younus, Tyler Zeoli, Keyan Peterson, Zeeshan M Sardar, Scott L Zuckerman","doi":"10.1227/ons.0000000000001649","DOIUrl":"https://doi.org/10.1227/ons.0000000000001649","url":null,"abstract":"<p><strong>Background and objectives: </strong>When performing a 3-column osteotomy (3CO) in adult spinal deformity surgery, osteotomy closure carries major risk. The construct-to-construct closure technique has been previously described as a safe means to close a 3CO. We sought to provide an in-depth description of the construct-to-construct closure technique through a case series using illustrations and intraoperative pictures and videos for spine surgeons looking to incorporate this technique.</p><p><strong>Methods: </strong>A retrospective, single-surgeon case series was undertaken of 3COs using the construct-to-construct closure technique. A detailed description of the technique with corresponding illustrations was provided. For each case, a summary with key intraoperative pictures and videos was included. Descriptive statistics were performed.</p><p><strong>Results: </strong>Seven patients (mean age: 57.1 ± 10.2 years; 57% females) underwent a 3CO with mean follow-up of 12 months at the following levels: L4, T11, L3, T10, T10-12, T12, and L2. Construct-to-construct closure was used in all cases with a mean correction of 36.3° ± 5.8° (range 28°-47°). Neuromonitoring data were stable in 5 cases, but a significant decrease in data was seen during osteotomy closure in 2 cases. In the 2 cases where data were lost, the correction was quickly released in a controlled manner and the postoperative neurological examination was stable to improved. No cases of screw pullout, screw plowing, or subluxation occurred.</p><p><strong>Conclusion: </strong>The current case series provides an in-depth description of the construct-to-construct closure technique to close a 3CO and is accompanied by illustrations and intraoperative pictures and videos.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple Microvascular Decompression for Hemifacial Spasm Caused by Dolichoectatic Vertebral Artery.","authors":"Adel Azghadi, Marte van Keulen, Sepideh Amin-Hanjani","doi":"10.1227/ons.0000000000001655","DOIUrl":"https://doi.org/10.1227/ons.0000000000001655","url":null,"abstract":"<p><strong>Background and importance: </strong>Hemifacial spasm (HFS) secondary to a dolichoectatic vertebral artery (VA) is a rare but debilitating condition. Macrovascular displacement of the vessel away from the nerve using a Teflon sling is an effective, but not always feasible, method. Transection, relocation, and reanastomosis of the dolichoectatic VA has also been described but presents a significant surgical challenge and carries a higher risk profile. In this case report, we demonstrate that simple microvascular decompression by translocation of the compression point away from the root entry zone (REZ) is an effective measure in treating HFS in this setting.</p><p><strong>Clinical presentation: </strong>A 67-year-old patient presented with debilitating left-sided HFS secondary to a large torturous VA abutting the facial nerve root entry point at the brainstem. The patient underwent retrosigmoid craniotomy, and the dolichoectatic VA was able to be mobilized away from the REZ, although compression remained along the cisternal segment. Using Teflon pledgets, the compression point caused by the VA at the REZ was carefully padded, and despite residual compression in the more distal cisternal nerve segment, the patient experienced complete resolution of symptoms.</p><p><strong>Conclusion: </strong>HFS caused by a dolichoectatic vessel poses a challenge for complete surgical decompression. We demonstrate that decompression of the REZ alone represents a simple and effective solution, resulting in complete resolution of the symptoms without the need to resort to more complex and potentially riskier options.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lead-Shift Error and Pneumocephalus in Awake, Robotic Deep Brain Stimulation Patients.","authors":"Sibi Rajendran, Lokeshwar S Bhenderu, Jesus G Cruz-Garza, John D Patterson, Shourya Kumar, Paras Gupta, Taimur Hassan, Khaled M Taghlabi, Amir H Faraji","doi":"10.1227/ons.0000000000001642","DOIUrl":"https://doi.org/10.1227/ons.0000000000001642","url":null,"abstract":"<p><strong>Background and objectives: </strong>The mechanisms of lead placement error and brain shift in deep brain stimulation (DBS) remain poorly understood. Further understanding is critical as lead displacement >2 mm can lead to poor treatment efficacy. Differences between anesthesia and surgical techniques often vary significantly, making the cause of error challenging to ascertain. The objective of this study was to demonstrate the relationship between pneumocephalus and lead shift error in patients undergoing awake, robotic-assisted surgery.</p><p><strong>Methods: </strong>Seventy-six patients undergoing DBS with target ventral intermediate nucleus of the thalamus (VIM) or subthalamic nucleus (STN) were included. All patients underwent bilateral lead placement under robotic guidance in an awake procedure, with left-sided leads placed first, followed by right-sided leads. Preoperative plan target points were compared with the final lead placement based on stereotactic computed tomography performed immediately postoperatively. The radial error between the postoperative computed tomography observation of the lead placement and the planned target was compared with the volume of pneumocephalus in the left vs right leads.</p><p><strong>Results: </strong>All patients had some degree of pneumocephalus, with an average amount of 18.9 ± 15.8 cm3 for both STN and VIM targets combined. The right-sided leads were placed medially to the planned target for both STN and VIM. There was a significant increase in the error magnitude for right-sided leads compared with left-sided leads for both STN and VIM targets (P < .01). Pneumocephalus was similar when comparing STN and VIM placement. No significant correlation existed between the total volume of pneumocephalus measured and lead misplacement.</p><p><strong>Conclusion: </strong>This study contributes valuable insights into lead placement errors and pneumocephalus variability in bilateral DBS procedures in awake patients. Addressing these issues, correcting for possible systematic errors during preoperative planning, and further exploring the relationship between pneumocephalus and lead placement accuracy can optimize the therapeutic benefits of DBS.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow Diversion in Patients With Concurrent Anticoagulation: Multicenter Experience and Systematic Review of Literature.","authors":"Joanna M Roy, Basel Musmar, Sravanthi Koduri, Alessandra Baldari, Zachary Sokol, Cheritesh Amaravadi, Spyridon Karadimas, Osman Kozak, Larami Mackenzie, Richard F Schmidt, Ritam Ghosh, Stavropoula I Tjoumakaris, M Reid Gooch, Hekmat Zarzour, Robert H Rosenwasser, Pascal M Jabbour","doi":"10.1227/ons.0000000000001660","DOIUrl":"https://doi.org/10.1227/ons.0000000000001660","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dual antiplatelet therapy is used to minimize thromboembolic complications after flow diversion (FD). Oral anticoagulation (AC) has been associated with increased risk of hemorrhagic complications. Our multicenter study and systematic review of literature describes the safety and efficacy of FD in patients on concurrent AC.</p><p><strong>Methods: </strong>This was a retrospective study of patients on concurrent AC before FD for an intracranial aneurysm at 3 participating institutions between January 2018 and January 2024. Outcomes of interest were angiographic occlusion (assessed using the O'Kelly-Marotta (OKM) Grade), postoperative complications, in-stent stenosis, and functional outcome (measured using the modified Rankin Scale). PubMed was searched to identify articles that reported outcomes of interest in patients undergoing FD on AC.</p><p><strong>Results: </strong>Nineteen patients with 20 aneurysms underwent FD while on AC. The median age of the cohort was 71%, and 89.4% were female (n = 17). Forty percentage (n = 8) of aneurysms were completely occluded (OKM grade D) and 20% (n = 4) developed clinically asymptomatic in-stent stenosis at their last follow-up. Overall, 84.2% of patients (n = 16) were functionally independent, 1 patient was lost to follow-up and 2 patients experienced mortality. Our systematic review of literature identified 2 articles describing rates of occlusion ranging from 25% to 71.4%, with increased rates of delayed rupture and retreatment among patients on AC.</p><p><strong>Conclusion: </strong>We report low rates of complete aneurysm obliteration after FD in patients on concurrent AC. Future research could help identify the appropriate antithrombotic regimen in this cohort.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Intraoperative Imaging Modalities in Surgical Resection of Supratentorial Gliomas: A Review of 300 Cases.","authors":"Hajrullah Ahmeti, Mareike Ziegler, Ulrich Stefenelli, Christoph Röcken, Olav Jansen, Hubertus Maximilian Mehdorn, Michael Synowitz","doi":"10.1227/ons.0000000000001628","DOIUrl":"https://doi.org/10.1227/ons.0000000000001628","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraoperative tumor visualization is an essential factor for successful glioma surgery. The aim of this study was to examine the extent of glioma resection and the patients' postoperative clinical conditions after resection with intraoperative imaging guidance (iMRI and \"modern\" ultrasound combined with neuronavigation [iUS]) and without intraoperative imaging guidance.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 300 glioma patients who underwent surgery for supratentorial low-grade gliomas and high-grade gliomas at our department between 2015 and 2022.</p><p><strong>Results: </strong>Among all the patients, 65 (21.7%) underwent tumor resection under iMRI guidance, and 35 (11.7%) underwent tumor resection under iUS guidance. Two hundred patients (66.7%) underwent tumor resection without intraoperative imaging control. Gross total resection (GTR) was achieved in 125 patients (41.7%) in the entire cohort. GTR was significantly more common under iMRI (56.9%) and iUS (57.1%), than without intraoperative imaging guidance (34%) (P = .001). The mean extent of tumor resection of contrast enhancement was the highest in the iMRI subgroup (96.6%), followed by the iUS subgroup (93.2%) and the subgroup without intraoperative imaging (92%) (P = .002). The 2 most common postoperative new neurological deficits were cognitive deficits (8%) and speech disorders (7.3%). Patients without intraoperative imaging guidance had weakness significantly more often (odds ratio = 0.520, CI = 0.272-0.994, P = .048) than patients with iMRT or iUS. The Karnofsky Performance Status score at 1 year after surgery was the lowest in patients without intraoperative imaging guidance. Multiple regression analyses for progression-free survival did not reveal any significant differences between the subgroups. Overall survival was significantly worse in patients without intraoperative imaging guidance (odds ratio = 1.534, CI = 1.058-2.225, P = .024) than in patients with iMRI and iUS.</p><p><strong>Conclusion: </strong>For glioma patients, GTR is more commonly performed under iMRI and iUS, than without intraoperative imaging guidance. Patients without intraoperative imaging control have significantly higher incidences of postoperative weakness and significantly worse overall survival than patients with iMRI and iUS.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Risk of Cerebral Parenchymal Hemorrhage After Thrombectomy in Acute Ischemic Stroke With Dynamic Cerebral Autoregulation.","authors":"Ran Liu, Songwei Chen, Liuping Cui, Hongxiu Chen, Xijuan Pan, Fubo Zhou, Wenbo Zhao, Yingqi Xing","doi":"10.1227/ons.0000000000001643","DOIUrl":"https://doi.org/10.1227/ons.0000000000001643","url":null,"abstract":"<p><strong>Background and objectives: </strong>Parenchymal hematoma (PH) worsens the prognosis in acute ischemic stroke patients who undergo endovascular thrombectomy (EVT). Dynamic cerebral autoregulation (dCA), the brain's ability to maintain stable cerebral blood flow despite fluctuating blood pressure, may be impaired in these patients. However, the relationship between PH and dCA remains unclear. The aim of this study was to investigate the correlation between PH after EVT and impaired dCA.</p><p><strong>Methods: </strong>We recruited patients who suffered from anterior large-vessel occlusion and underwent EVT. The dCA parameters, including gain, phase, and coherence, were measured 24 hours and 2-3 days post-EVT. The change in phase between these time points was calculated (Δphase = phase2-3 d - phase24 h). The European Cooperative Acute Stroke Study II guidelines were used to evaluate PH. Clinical outcomes were measured by the modified Rankin scale at 3 months post-EVT, with a modified Rankin scale score below 3 indicating a favorable outcome.</p><p><strong>Results: </strong>There was an independent correlation between PH and unfavorable outcomes (odds ratio [OR]: 6.66, 95% CI: 1.46-31.08, P = .016). Phase at 2-3 days post-EVT was significantly associated with PH (P = .045). Δphase (OR: 0.91, 95% CI: 0.94-0.99, P = .014) was an independent factor of PH. The optimal Δphase cutoff was -10°, with an area under the curve of 0.715 (sensitivity 82.6%, specificity 70.0%, P = .043).</p><p><strong>Conclusion: </strong>Poor results in acute ischemic stroke patients after EVT are independently predicted by PH. Modifications to dCA from 24 hours to 2-3 days post-EVT may be a novel marker for PH.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Evaluation of Dural Arteriovenous Fistula Obliteration Using FLOW 800 Hemodynamic Analysis.","authors":"Karl L Sangwon, Eric A Grin, Bruck Negash, Daniel D Wiggan, Cathryn Lapierre, Eytan Raz, Maksim Shapiro, Ilya Laufer, Vera Sharashidze, Caleb Rutledge, Howard A Riina, Eric K Oermann, Erez Nossek","doi":"10.1227/ons.0000000000001646","DOIUrl":"https://doi.org/10.1227/ons.0000000000001646","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dural arteriovenous fistula (dAVF) surgery is a microsurgical procedure that requires confirmation of obliteration using formal cerebral angiography, but the lack of intraoperative angiogram or need for postoperative angiogram in some settings necessitates a search for alternative, less invasive methods to verify surgical success. This study evaluates the use of indocyanine green videoangiography FLOW 800 hemodynamic intraoperatively during cranial and spinal dAVF obliteration to confirm obliteration and predict surgical success.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using indocyanine green videoangiography FLOW 800 to intraoperatively measure 4 hemodynamic parameters-Delay Time, Speed, Time to Peak, and Rise Time-across venous drainage regions of interest pre/post-dAVF obliteration. Univariate and multivariate statistical analyses to evaluate and visualize presurgical vs postsurgical state hemodynamic changes included nonparametric statistical tests, logistic regression, and Bayesian analysis.</p><p><strong>Results: </strong>A total of 14 venous drainage regions of interest from 8 patients who had successful spinal or cranial dAVF obliteration confirmed with intraoperative digital subtraction angiography were extracted. Significant hemodynamic changes were observed after dAVF obliteration, with median Speed decreasing from 13.5 to 5.5 s-1 (P = .029) and Delay Time increasing from 2.07 to 7.86 s (P = .020). Bayesian logistic regression identified Delay Time as the strongest predictor of postsurgical state, with a 50% increase associated with 2.16 times higher odds of achieving obliteration (odds ratio = 4.59, 95% highest density interval: 1.07-19.95). Speed exhibited a trend toward a negative association with postsurgical state (odds ratio = 0.62, 95% highest density interval: 0.26-1.42). Receiver operating characteristic-area under the curve analysis using logistic regression demonstrated a score of 0.760, highlighting Delay Time and Speed as key features distinguishing preobliteration and postobliteration states.</p><p><strong>Conclusion: </strong>Our findings demonstrate that intraoperative FLOW 800 analysis reliably quantifies and visualizes immediate hemodynamic changes consistent with dAVF obliteration. Speed and Delay Time emerged as key indicators of surgical success, highlighting the potential of FLOW 800 as a noninvasive adjunct to traditional imaging techniques for confirming dAVF obliteration intraoperatively.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental Lordosis After Open Transforaminal Lumbar Interbody Fusion Using Expandable Oblique Versus Static Anterior Banana Cages.","authors":"David Ben-Israel, Brian J Park, Connor Berlin, Faraz Farzad, Hong Joo Moon, Mark E Shaffrey, Juan P Sardi, Chun-Po Yen, Justin S Smith","doi":"10.1227/ons.0000000000001639","DOIUrl":"https://doi.org/10.1227/ons.0000000000001639","url":null,"abstract":"<p><strong>Background and objectives: </strong>Expandable oblique interbody cages have gained popularity because of their suitability in minimally invasive surgical approaches and their ease of operative insertion. We aimed to determine whether static anteriorly placed banana cages or expandable obliquely placed cages provide greater lordosis when performing open transforaminal lumbar interbody fusion with concomitant posterior column osteotomy (PCO).</p><p><strong>Methods: </strong>We performed a single-surgeon retrospective consecutive cohort study which compared patients who underwent transforaminal lumbar interbody fusion using a static anteriorly placed banana cage vs an expandable obliquely placed cage. All TLIFs were performed open with PCO and included patients with focal degenerative pathology as well as global spinal deformity. Patient data were collected preoperatively, at 6-month follow-up, and at the last available follow-up. The primary outcome was defined as the change in segmental lordosis (ΔSL) measured using 6-month postoperative upright lumbar spine x-rays.</p><p><strong>Results: </strong>In total, 210 patients met inclusion criteria, including a total of 227 static cages and 100 expandable cages. The median ΔSL for the expandable cohort was significantly higher than the static cohort (6.1° [2.4, 8.4] vs 4.1° [1.3, 6.9], P = .016). This difference persisted after multivariate regression analyses and propensity score matching. Preoperative SL was found to have the greatest impact on ΔSL with a 3.23° increase for segments with preoperative SL < 15° compared with segments with preoperative SL ≥ 25° (P < .001). The overall median (T12-S1) delta lumbar lordosis (ΔLL) for all patients was 3.5° [-0.5, 10.2]. Although ΔLL was larger for static cages (median difference of 2.2°, P = .031), after propensity score matching, the expandable cage cohort experienced 3.24° greater ΔLL compared with the static cohort (P = .004).</p><p><strong>Conclusion: </strong>Open TLIFs performed in conjunction with a PCO yielded 2.0° greater median ΔSL when using expandable obliquely placed cages compared with using static anteriorly placed banana cages. This represents a 50% increase between static and expandable cages. Cage type did not provide a clear advantage for overall ΔLL.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical Endoscope-Assisted Removal of a Pulvinar Glioma Through a Supracerebellar Transtentorial Approach to the Cisternal Surface of the Thalamus: 2-Dimensional Operative Video.","authors":"Luca Zanuttini, Victor E Staartjes, Stefanos Voglis, Elisa Colombo, Philipp Bardelli, Carlo Serra","doi":"10.1227/ons.0000000000001661","DOIUrl":"https://doi.org/10.1227/ons.0000000000001661","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}